Housing over 8,000 patients at its peak in the 1950s, the hospital had a fully functioning medical-surgical unit, a school of nursing, accredited internships and psychiatric residencies.

[3] Since 2010, the hospital's functions have been limited to the portion of the East Campus operated by the District of Columbia Department of Mental Health.

The West Campus was transferred to the United States Department of Homeland Security for its headquarters and its subsidiary agencies.

Approximately 450 graves of Civil War veterans and an unknown number of civilians are buried on the West Campus.

Dorothea Dix (1802–1887) served as a pioneering advocate for people living with mental illnesses and she helped convince legislators of the need for the hospital.

[8] Dix, who was on friendly terms with U.S. President Millard Fillmore, was asked to assist the Interior Secretary in getting the hospital started.

[9] His 1854 manual recommended specifics such as site, ventilation, number of patients, and the need for a rural location proximate to a city.

During the Civil War, the West Lodge, originally built for male African-American patients, was used as a general hospital by the U.S. Navy.

The unfinished east wing of the main building was used by the U.S. Army as a general hospital for sick and wounded soldiers.

In the late 19th century, the hospital temporarily housed animals that were brought back from expeditions for the Smithsonian Institution.

In this period, it applied electro-shock and other treatments in an attempt to convert homosexual individuals to heterosexuals, in the mistaken belief that they were suffering from mental illness.

The District of Columbia struggled with the poor conditions from years of neglect and inadequate funding: equipment and medicine shortages occurred frequently, and the heating system was broken for weeks at a time.

[20] In January 2015, DC Auditors dismissed the settlement agreement and officially ended oversight of St. Elizabeths Hospital.

[21] A new civil and forensic hospital was built on the East Campus by the District of Columbia Department of Mental Health and opened in the spring of 2010, housing approximately 297 patients.

By the early 21st century the District of Columbia had made plans to redevelop St. Elizabeths' East Campus for mixed-use and residential rental property.

It planned to spend approximately $4.1 billion for renovations and adaptive reuse of buildings, in order to relocate its headquarters and most of its Washington-based offices to a new 4,500,000-square-foot (420,000 m2) facility on the site.

Delegate Eleanor Holmes Norton, DC Mayor Adrian Fenty, and acting GSA administrator Paul Prouty.

[33][34] By April 2020, because of the surge in the COVID-19 pandemic and illness among staff, the DHS National Operations Center relocated to Mount Weather in an effort to reduce or prevent infections of critical personnel.

[35] Well-known patients of St. Elizabeths have included would-be presidential assassins Richard Lawrence, who attempted to kill Andrew Jackson, and John Hinckley Jr., who shot Ronald Reagan.

Notable residents from civil commitments were Mary Fuller, a stage and silent film actress and early star; William Chester Minor, who made major contributions to the Oxford English Dictionary while committed to an asylum in Great Britain; American poet Ezra Pound, a fascist collaborator during World War II; and Frances Wieser, a scientific illustrator.

[14] According to reporter Kelly Patricia O'Meara, St. Elizabeths is believed to have treated more than 125,000 patients; an exact number is not known because of poor record keeping and the division of responsibilities among different agencies over the years.

The General Services Administration, current owner of the property, considered using ground-penetrating radar to attempt to locate unmarked graves, but has yet to do so.

[37] In addition to mental health patients buried on the campus, several hundred American Civil War soldiers are interred at St.

[39] During American involvement in World War II, the Office of Strategic Services (OSS), the predecessor to the Central Intelligence Agency, used facilities and staff at St. Elizabeths Hospital to test "truth serums".

OSS tested a mescaline and scopolamine cocktail as a truth drug on two volunteers at St. Elizabeths Hospital, but found the combination unsuccessful.

[40] In 1963, Dr. Luther D. Robinson, the first African American superintendent of St. Elizabeths, founded the mental health program for the deaf.

[8] The campus of St. Elizabeths is located on bluffs overlooking the confluence of the Potomac and Anacostia rivers in the southeast quadrant of Washington, D.C.

The number of patients had steadily declined since the mid-20th century as community alternatives were sought for large mental institutions.